1. CARRE
Personalized patient empowerment and shared decision
support for cardiorenal disease and comorbidities
Risk Factor Repository Evaluation
September 2016

2. FP7 – ICT - 614440 http://www.carre-project.eu
CARRE
Cardiorenal
comorbidity management
via empowerment and
shared informed decision
FP7-ICT-2013-611140
consortium: 6 partners from 4 EU countries
coordinator: Eleni Kaldoudi (DUTH)
duration: Nov 2013 – Oct 2016
budget: 3,210,470€
http://carre-project.eu/
Democritus Univ. of Thrace
DUTH, GR
The Open
University, UK
Univ. of Bedfordshire, UK Vilnius Univ. Hospital, LT
Kaunas Univ., LT
Industrial Research Institute
for Automation & Measurements, PL

3. FP7 – ICT - 614440 http://www.carre-project.eu
motivation
 significant increase in the prevalence and incidence
of chronic disease
 ½ of all chronic patients
present comorbidities
 the chronic patient is mostly
an outpatient
 needs to care for herself at home
 mainly away from
continuous professional care
 while trying to lead a normal life
prevent
detect
manage

4. FP7 – ICT - 614440 http://www.carre-project.eu
medical domain
chronic cardiorenal disease and comorbidities
 simultaneous (causal) dysfunction of kidney and heart
 diabetes and/or hypertension common underlying causes
 a number of other serious comorbidities often present
nephrogenic anemia, renal osteodystrophy, malnutrition,
blindness, neuropathy, severe atherosclerosis,
cardiovascular episodes, and eventually
end-stage renal disease and/or heart failure,
and death
 deterioration to end stage renal/heart disease is
life threatening, irreversible and expensive to manage

5. FP7 – ICT - 614440 http://www.carre-project.eu
cardiorenal disease & comorbidities
some numbers…
 hypertension  1/3 of adults (US 2008)
 diabetes  8% of overall population
 chronic kidney disease  9-16% of overall population
 44% of chronic kidney disease is due to diabetes
 86% of chronic kidney disease has at least 1 comorbidity
 most patients with chronic kidney disease develop
cardiovascular disease
 chronic heart failure  1-2% of total healthcare costs
 end-stage renal disease (dialysis)  >2% of total healthcare costs

6. FP7 – ICT - 614440 http://www.carre-project.eu
CARRE
approach
foster understanding of comorbid condition
calculate informed comorbidity progression
compile personalized empowerment services
support shared informed decision and
integrated management

7. FP7 – ICT - 614440 http://www.carre-project.eu
medical evidence
aggregation
evidence based
medical literature
Educational
resources
…
social media
personal health
information
quantified
self
weight
physical activity
blood pressure
glucose
CARRE approach
private
public
data harvesting
& interlinking
LOD
comorbidity model visualization
(generic and personalized)
patient empowerment &
decision support services

8. FP7 – ICT - 614440 http://www.carre-project.eu
modelling health risk factors
disorder 1
(as a risk factor)
disorder 2
(as a probable
consequence)
leads to
under certain
conditions
with a
probability x
E. Kaldoudi, et al. CARRE D.2.1, 2014
risk factors are reported in medical literature
(top level evidence: systematic reviews with meta-analysis)

9. characterizes
is a value of
type of risk
element
biomedical
ratio value confidence intervalratio type adjustment for
modelling health risk factors
E. Kaldoudi, et al. CARRE D.2.2, 2014
risk
element
observable
observable
condition
satisfies
observable
condition
1…N
determines
risk evidence
1…N
has
risk
ratio
risk ratio evidence source
has
evidence
source
source
risk
element
target
risk
element
causes, is an
issue in, …
risk evidence
demographic
genetic
behavioural
intervention
environmental
is a value of
1…N
measures the
state of risk
element
condition disorder
A. Third, E. Kaldoudi, G. Gotsis, S. Roumeliotis, K. Pafili, J. Domingue,
Capturing Scientific Knowledge on Medical Risk Factors, K-CAP2015, ACM, NY, USA, Oct. 7-10, 2015

10. risk factor identification methodology
search ground knowledge
to identify major risk factors
(guidelines and their literature: KDIGO,
KDOQI, ACC/AHA, NICE, ESC, EASD, ADA)
if result found
include all risk evidences
from the most recent
yes
search PubMed:
condition A AND condition B
(limited to systematic reviews
with metaanalyses
identify major
risk factors
(keywords)
search PubMed:
condition A AND
condition B
noif result found
include relevant risk evidence
from latest and highest level
yes
search again for next
update (1 year)
no
E. Kaldoudi, et al. CARRE D.2.2, 2014

11. FP7 – ICT - 614440 http://www.carre-project.eu
some of the major related conditions
1. Acute kidney injury
2. Acute myocardial infarction
3. Age
4. Albuminuria
5. Anaemia
6. Angina pectoris
7. Asthma
8. Atrial fibrillation
9. Chronic kidney disease
10. Chronic obstructive
pulmonary disease
11. Cholelithiasis
12. Colorectal Cancer
13. Coronary and carotid
revascularisation
14. Death
15. Depression
16. Diabetes
17. Diabetic nephropathy
18. Drugs
19. Dyslipidemia
20. Family history
21. Heart Failure
22. Hyperkalemia
23. Hypertension
24. Hyperuricemia
25. Hypoglycaemia
26. Ischemic heart disease
27. Ischemic stroke
28. Left ventricular hypertrophy
29. Obesity
30. Obstructive Sleep Apnoea
31. Myocardial infarction
32. Osteoarthritis
33. Pancreatic Cancer
34. Peripheral Arterial Disease
35. Physical activity
36. Smoking
37. …

12. FP7 – ICT - 614440 http://www.carre-project.eu
obesity diabetescauses
when 23BMI34
risk ratio = 1.61
obesity hypertensioncauses
when 99.4  Waist Circumference  106.2 AND sex=male
risk ratio = 2.50
obesity heart failurecauses
when 25  BMI  30 AND sex=female
risk ratio = 2.50

13. FP7 – ICT - 614440 http://www.carre-project.eu
hypertension
chronic renal
diseasecauses
when systolic BB  140mmHg AND/OR diastolic BB  90 mmHg
risk ratio = 2.00
smoking
chronic renal
disease
is an issue in
when smoking status = current AND sex=male
risk ratio = 2.40
so far… 253 major risk associations (or evidences) identified in medical literature
(which involve 53 health conditions and 82 related observables)
as included in the CARRE risk factor database and predictive model

14. FP7 – ICT - 614440 http://www.carre-project.eu
risk factor reference repository
https://entry.duth.carre-project.eu/

15. FP7 – ICT - 614440 http://www.carre-project.eu
https://entry.duth.carre-project.eu/

16. FP7 – ICT - 614440 http://www.carre-project.eu
risk factors

17. FP7 – ICT - 614440 http://www.carre-project.eu
risk factors

18. FP7 – ICT - 614440 http://www.carre-project.eu
risk evidences

19. FP7 – ICT - 614440 http://www.carre-project.eu
risk factor reference repository

20. FP7 – ICT - 614440 http://www.carre-project.eu
risk factor reference repository

21. FP7 – ICT - 614440 http://www.carre-project.eu
risk factor reference repository

22. FP7 – ICT - 614440 http://www.carre-project.eu
risk factor reference repository

23. FP7 – ICT - 614440 http://www.carre-project.eu
risk elements

24. FP7 – ICT - 614440 http://www.carre-project.eu
observables

25. FP7 – ICT - 614440 http://www.carre-project.eu
experts

26. FP7 – ICT - 614440 http://www.carre-project.eu
experts

27. FP7 – ICT - 614440 http://www.carre-project.eu
evaluation scenarios and procedure
 explore the system
 login
 dashboard – browse and evaluate
 explore – visual exploration of the data
 study risk evidence – navigate and study risk evidences
 edit data – edit data and insert new evidence
 answer the evaluation survey
 discuss your comments and suggestions

28. acknowledgment
work funded under project CARRE
co-funded by the
European Commission under the
Information and Communication Technologies (ICT)
7th Framework Programme
Contract No. FP7-ICT-2013-611140
CARRE: Personalized patient empowerment
and shared decision support
for cardiorenal disease and comorbidities
http://www.carre-project.eu/

29. Contact
Eleni Kaldoudi
Associate Professor
School of Medicine
Democritus University of Thrace
Alexandroupoli, Greece
Tel: +302551030329
Tel: +30 6937124358
Email: kaldoudi@med.duth.gr
Email: carre@med.duth.gr
http://www.carre-project.eu